Provider Demographics
NPI:1922348986
Name:ST. LUKES HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP MANAGED CARE REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7577
Mailing Address - Street 1:PO BOX 637296
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7296
Mailing Address - Country:US
Mailing Address - Phone:419-893-5911
Mailing Address - Fax:
Practice Address - Street 1:5901 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1841
Practice Address - Country:US
Practice Address - Phone:419-893-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH220964291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH360090Medicare Oscar/Certification